Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations: A Report of the SHEER Task Force

Edward Henry (), Hareth Al-Janabi, Werner Brouwer, John Cullinan, Lidia Engel, Susan Griffin, Claire Hulme, Pritaporn Kingkaew, Andrew Lloyd, Nalin Payakachat, Becky Pennington, Luz María Peña-Longobardo, Lisa A. Prosser, Koonal Shah, Wendy J. Ungar, Thomas Wilkinson and Eve Wittenberg
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Edward Henry: University of Galway
Hareth Al-Janabi: University of Birmingham
John Cullinan: University of Galway
Lidia Engel: Monash University
Susan Griffin: University of York
Claire Hulme: University of Exeter Medical School
Pritaporn Kingkaew: Ministry of Public Health
Andrew Lloyd: Acaster Lloyd Consulting Ltd
Nalin Payakachat: University of Arkansas for Medical Sciences (UAMS)
Becky Pennington: University of Sheffield
Luz María Peña-Longobardo: University of Castilla-La Mancha
Lisa A. Prosser: University of Michigan
Koonal Shah: National Institute for Health and Care Excellence
Wendy J. Ungar: The Hospital for Sick Children Research Institute/University of Toronto
Thomas Wilkinson: University of Cape Town
Eve Wittenberg: Harvard University

PharmacoEconomics, 2024, vol. 42, issue 3, No 8, 343-362

Abstract: Abstract Background Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. Aim To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. Methods A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. Results This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. Conclusions Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.

Date: 2024
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DOI: 10.1007/s40273-023-01321-3

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